De Marco Rocco, Aurilia Pasquale, Mele Alessandro
Department of Ophthalmology, Cardinale Ascalesi Hospital-ASLNA1, Napoli - Italy.
Eur J Ophthalmol. 2009 Sep-Oct;19(5):883-6. doi: 10.1177/112067210901900534.
To report a case of massive spontaneous choroidal hemorrhage in a patient with chronic renal failure and coronary artery disease treated with clopidogrel bisulfate (Plavix).
Case report.
A 75-year-old man presented with pain and loss of vision in the left eye for 1 week. His medical history was remarkable for systemic hypertension, chronic renal failure, and artery coronary disease. For 6 months, he had been taking 75 mg/day of Plavix after coronary angioplasty. Ocular examination revealed the patient to be in angle closure. Ultrasonography and computed tomography scan revealed a massive choroidal hemorrhage pushing the iris-lens diaphragm forward. Pain and intraocular pressure were treated successfully with evacuative sclerotomies, but the final exitus after 6 months was bulbar phthisis.
Massive spontaneous choroidal hemorrhage is an extremely rare event that usually has been described in older patients (65-87 years old) receiving anticoagulants or thrombolytic agents. Systemic hypertension, generalized atherosclerosis, and age-related macular degeneration are additional risk factors. In the present case, massive choroidal hemorrhage was associated with use of clopidogrel bisulfate (Plavix) in a patient with chronic renal failure. Our report indicates that Plavix should be administered with caution in patients with chronic renal failure owing to the risk of serious choroidal bleeding. Chronic renal failure should be also included in the list of risk factors for massive spontaneous choroidal hemorrhage. Evacuative sclerotomies may have value in the relief of pain and elevated intraocular pressure but has not been shown to be beneficial in visual and anatomic outcomes.
报告一例在接受硫酸氢氯吡格雷（波立维）治疗的慢性肾衰竭和冠状动脉疾病患者中发生的大量自发性脉络膜出血病例。
病例报告。
一名75岁男性因左眼疼痛和视力丧失1周前来就诊。他有系统性高血压、慢性肾衰竭和冠状动脉疾病病史。冠状动脉血管成形术后6个月，他一直每天服用75毫克波立维。眼部检查发现患者为闭角型青光眼。超声检查和计算机断层扫描显示大量脉络膜出血将虹膜 - 晶状体隔向前推移。通过引流性巩膜切开术成功治疗了疼痛和眼压，但6个月后的最终结局是眼球痨。
大量自发性脉络膜出血是一种极其罕见的事件，通常在接受抗凝剂或溶栓剂治疗的老年患者（65 - 87岁）中有所描述。系统性高血压、全身性动脉粥样硬化和年龄相关性黄斑变性是其他危险因素。在本病例中，大量脉络膜出血与一名慢性肾衰竭患者使用硫酸氢氯吡格雷（波立维）有关。我们的报告表明，由于存在严重脉络膜出血的风险，慢性肾衰竭患者应谨慎使用波立维。慢性肾衰竭也应列入大量自发性脉络膜出血的危险因素清单。引流性巩膜切开术可能对缓解疼痛和眼压升高有价值，但尚未证明对视力和解剖学结局有益。
